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When Physical Therapy Doesn’t Work

One barrier to getting people to come to physical therapy is that they have had physical therapy before and feel that it didn’t work or help.  But, all physical therapy IS NOT the same. While physical therapy cannot “fix” everything, I have a strong conviction that failure in PT is often due to miscommunication between the therapist and the patient.

When people say PT didn’t work, my immediate response is to ask what success in PT looks like for the person.  Your therapist should fully understand your expectation for PT and this is often not what we as therapists might perceive. This question should be asked explicitly and discussion should follow regarding the specifics of a successful treatment in the eyes of the patient.  For example, if someone has been experiencing back pain for 15+ years and state that they want to be pain-free, a discussion needs to happen. Is pain-free reasonable? If you are not pain-free, but 50% better, what type of things are you going to be able to do with greater ease or better ability?  Your therapist should be asking if you think being pain-free is a reasonable goal and diving into these potential barriers and beliefs about this goal. In short, if you were not asked directly and with detail what a successful treatment would like to you when starting PT, then it isn’t failed treatment, it is a lack of understanding between the patient and the therapist.

Likewise, you and your therapist should be convinced each session that you are making progress. Each session of PT should include questions about changes in specific tasks outside of PT as well as consistent measurements to determine if changes were maintained since the last session.  If you are waiting 10 visits or 6 weeks, for example, to have measures re-evaluated, you and the therapist are crossing your fingers and hoping things change. “Failed PT” should not happen if you know each and every time you come to PT whether you have maintained progress or regressed.

If you are not making progress within sessions or between sessions, you and your therapist should be having conversations regarding other options.  Sometimes, PT is not working to move people forward and your therapist should be competent and confident enough to tell you. You should know if your therapist is concerned or if treatment isn’t progressing as expected.  Likewise, your therapist should know if you are not seeing the results you expect. A good patient-therapist alliance is important to move you forward. If you “failed PT” in the past, but never had discussions that things were not progressing as expected until the last day of PT, again a lack of communication is to blame.

So, before you decide that you have already had therapy and it didn’t work, question if your therapy was really tailored to you.  Did you and your therapist clearly state what success would like and take specific measures each visit to know if you were making progress that was meaningful not just to the therapist, but to you? Did these measures assess functional tasks that you have been challenged to perform in the manner you would like?

All therapy and therapists are not the same.  Finding a therapist that is truly engaged in your individualized care is pertinent to success with physical therapy. If you or someone you know has gone through therapy before with limited success, ask if success was defined and consider giving PT another chance.